1. Applicant must read and sign the Application Agreement
on page 2 of the application.
2. Applicant must meet the scholarship eligibility
criteria (listed below) to be eligible to make application.
3. Applicant must complete and attach an online College
Costs Estimator confirmation page or number or submit a paper Estimator with
the application. (Please call the Foundation with any questions).
4. Applicant must be a current year graduating senior
from Rising Sun High School and obtain their diploma by June 30th of
the current year.
5. Completed scholarship application and all required documents must be received in the Rising Sun High School Guidance Counselor’s Office by 3:00 p.m. on December 1, 2011. Late and incomplete applications will not be considered.
Dana Ballard
Memorial Scholarship
·
Applicant must
have maintained a 3.0 GPA on a 4.0 scale based on the last semester completed.
·
Applicant must be
pursuing a Bachelor’s Degree in a field such as fitness training, sports
training or physical therapy.
·
Applicant must
complete a one page, essay based on the application Essay Question for this
scholarship (page 7).
Ohio County Joint
Community Scholarship
·
Applicant must
have attended Rising Sun High School during both their entire junior and senior
years of high school.
·
Applicant must
have maintained a 3.0 GPA on a 4.0 scale based on the last semester completed.
·
Applicant will be
evaluated at the Scholarship Selection Committee’s discretion based on the
level of Community Service activities performed in Ohio County.
·
Applicant must
plan to pursue a 2-year or 4-year degree.
Phyllis A. Brown
Memorial Scholarship
·
Applicant must
have maintained a 2.75 GPA on a 4.0 scale based on the last semester completed.
·
Applicant must
plan to pursue a degree in a post secondary educational institution such as a
technical, community college or four-year college or university.
·
Recipient of the
scholarship will be selected at random by the Ohio County Community Foundation
Scholarship Selection Committee from a pool of eligible applicants.
Brinson Williamson Memorial Scholarship
·
Applicant must
have maintained a 2.0 GPA on a 4.0 scale based on the last semester completed.
·
Applicant must
have been a band/music student or continuing their education in the music
field.
·
Applicant must
submit the Teacher Evaluation Form (page 6) completed by one current or past
music teacher.
·
Applicant must
complete a one page, essay based on the application Essay Question (page 7) for
this scholarship.
Steven W. McHenry Memorial Scholarship
·
Applicant must
have maintained a 2.0 GPA on a 4.0 scale based on the last semester completed.
·
Applicant must
have been a band/music student or continuing their education in the music
field.
·
Applicant must
submit the Teacher Evaluation Form (page 6) completed by one current or past
music teacher.
·
Applicant must
complete a one page, essay based on the application Essay Question (page 7) for
this scholarship.
DO NOT RETURN THIS INSTRUCTION
PAGE WITH YOUR APPLICATION
INSTRUCTIONS:
1. Please read the criterion associated
with each scholarship prior
to completing the application as it contains specific criteria for each
scholarship.
2. Read each section of the application
thoroughly, and make sure that each portion of the application is filled out. Incomplete
applications will not be considered.
3. To score
objectively, it is required that you include the last four digits of your
social security number in the lower left hand corner of each page of the
application. Do not include your name anywhere, other than on the application
cover form and agreement pages.
4. Please make sure all signature lines
are signed appropriately.
5. When completing
an essay for any of the scholarships, it is required that you title your
essay with the name of the scholarship.
a. If the essay is more than one page,
please include the scholarship’s name as a header on all subsequent
pages. DO NOT STAPLE.
b. Please be sure to include only the
last four digits of your social security number in the lower right hand
corner(s) of each page of the essay(s) for identification purposes.
c. Do not include your name, your
parents’ names, and/or your relatives’ names anywhere within your essay(s).
d.
All essays must be 500 words or less; doubled spaced with one inch margins.
6.
Questions should be directed to the OCCF Program Coordinator at 812/438-9401 or
email: sscott@occfrisingsun.com.
7. As a way to help us determine financial need,
we require each applicant to complete an online College Costs Estimator.
Please Note: Even if you have completed a College Costs Estimator
in previous years, you will still need to submit a new one so that we can have
the most accurate, up-to-date information as possible. The
information you provide is not seen by
anyone on the Ohio County Community Foundation Staff, Scholarship Selection
Committee or Board. All information is considered personal and confident. It is processed independently by Murray & Associates of the National
Center for College Costs and compiled into a summary report of all
applicants. Each applicant is identified only by an assigned confirmation number. The financial need of an applicant is
determined by an applicant’s expected family contribution, anticipated
financial aid and any special circumstances deemed from the report and
application. The Foundation strongly feels this report is a fair and honest way
to determine financial need. Please see the Online Instruction Sheet included in the Scholarship
Packet for instructions as how to complete the online College Costs Estimator.
The College Costs Estimator must be completed before the application deadline
stated in the application. Failure to do so will result in the student being
ineligible for the scholarships in this application. If your family does not
have access to the internet, please contact the Community Foundation at
812-438-9401 and we can make arrangements to provide you with a paper Estimator
Form.
The College Costs Estimator program
also provides families with seniors and younger children with very helpful
information regarding financing a college education. A special workshop for all applicants and
their families will be conducted on Thursday,
January 12, 2012, at 6:00pm in the Rising Sun
High School Library. At that time, a final report will
be available with results from your College
Costs Estimator. Questions regarding
the College Costs Estimator may be directed to Murray & Associates
at 1-877-687-7291 (toll free).
8.
Completed scholarship applications and
all required documents must be received in the Rising Sun High School Guidance Counselor’s
Office by 3:00 p.m. on December 1, 2011.
Late applications will not be considered.
DO NOT RETURN THIS INSTRUCTION
PAGE WITH YOUR APPLICATION
Ohio County Community Foundation, Inc.
Class of 2012 Scholarship Application
PLEASE
TYPE OR PRINT LEGIBLY
APPPLICATION
DEADLINE IS DECEMBER 1, 2011 at 3:00PM
NAME: _________________________________________________________________
ADDRESS: _____________________________________________________________
CITY, STATE, ZIP________________________________________________________
PHONE: __________________________ EMAIL: ____________________________
BIRTHDATE: __________________________
LAST FOUR DIGITS OF SOCIAL SECURITY NUMBER: ______________________
MOTHER’S NAME_______________________________________________________
FATHER’S NAME________________________________________________________
I certify that I have read the Scholarship Criteria, Application Instructions and the College Costs Estimator Instruction Sheet and that I am eligible AND applying for the following (please check all appropriate scholarships):
Dana Ballard Memorial Scholarship ________
Ohio County Joint Community Scholarship ________
Phyllis A. Brown Memorial Scholarship ________
Brinson Williamson Memorial Scholarship ________
Steven W. McHenry Memorial Scholarship ________
___________________________________________ ____________
STUDENT SIGNATURE DATE
Page 1 Last 4 Digits of Social Security Number: _______
Application Number: _______
AGREEMENT
I,
___________________________________________, affirm that the information in
this application is true, and I affirm and agree that:
I am a current year graduating senior of Rising Sun
High School and will receive an Indiana Accredited High School Diploma by June
30th of the current year.
I have read the scholarship criterion and meet the
eligibility requirements for each scholarship in which I am making application.
I have no lineal relative currently
working as an OCCF staff member, serving on the OCCF Board of Directors or any
Foundation Committee or who has worked or served in these capacities within the
last 18 months.
Rising Sun High School has my permission to release my
transcript to the Ohio County Community Foundation.
I have completed an online College Cost Estimator Form or a paper College Costs Estimator Form
before the application deadline and the information I submitted is true and
accurate.
If I
prepared my College Cost Estimator online, I have attached a copy of my College Cost Estimator Confirmation Page
to this application. If I prepared a paper College Costs Estimator Form, I have
attached the form to the application in the provided, sealed envelope.
I hereby authorize Murray & Associates / The
National Center for College Costs to release any and all information reported
on the College Costs Estimator to the Ohio County Community Foundation
solely for use in the scholarship selection process of all scholarships
administered by the Ohio County Community Foundation. I understand that the
Ohio County Community Foundation will hold this information strictly
confidential and will use it only for scholarship selection purposes.
I have attended Rising Sun High School both my entire
Junior and Senior Year of High School. (Ohio
County Joint Community Scholarship)
I have participated in band, choir, or independent
music lessons or I plan to study music in college and have attached the
required Teacher Evaluation Form. (McHenry & Williamson Scholarships)
I have completed and attached the required essay. (Dana Ballard Scholarship; McHenry &
Williamson)
I understand that any applicant/recipient receiving a
full-tuition scholarship such as the Lilly Endowment Community Scholarship or
from another source within the same academic year of making application is not
eligible to receive scholarships administered by the Ohio County Community
Foundation.
I understand, if chosen as a recipient, all
scholarships are awarded solely for the purpose of payment for tuition and/or
books and that payment of the scholarship will be sent directly to the
educational institution in which I am enrolled.
If chosen as a recipient, I understand, that payment
of the scholarship will not be released until I submit a copy of my current
tuition bill to the Ohio County Community Foundation for the semester the
scholarship is intended to be applied. (Tuition bill must show tuition cost,
fees and any received financial aid).
If chosen as a scholarship recipient, I agree to abide
by the rules set forth by the Ohio County Community Foundation to include
communicating with them and providing all requested documentation in a timely
manner.
__________________________________________ __________________________________________
STUDENT SIGNATURE PARENT/GUARDIAN SIGNATURE
__________________________________________________ __________________________________________________
DATE DATE
Page 2 Last 4 Digits of Social Security Number: _______
Application Number: _______
ACADEMICS
ATTACH A COPY OF YOUR CURRENT
TRANSCRIPT TO THE APPLICATION
1.
What
diploma will you be receiving when you graduate high school? (Please check):
CORE 40 ____ CORE
40 with Academic Honors ____ CORE
40 with Technical Honors _____
2. SAT Scores: Writing ________ Math _______
Critical Reading ________ Total ________
3. ACT Composition: ___________
4. 
Intended College Choice:
_________ I am undecided on a College
at this time (Skip to question 6)
5. (Please check): Intended College is a:
__________ 2 Year College
__________ 4 Year College
__________ Vocational/Technical School
__________ Other:
_____________________________________
6. Colleges applied to (Please list by
priority choice): Colleges Accepted:
____________________________________________________________ ____Yes ____ No
____________________________________________________________ ____Yes ____ No
____________________________________________________________ ____Yes ____ No
____________________________________________________________ ____Yes ____ No
7. Intended Field of Study:
__________________________________________________
_________ I am undecided on a Field
of Study at this time
8. I plan to pursue a:
____ Bachelor’s Degree ____ Associates Degree ____ Certification
Page 3 Last 4 Digits of Social Security Number: _______
Application Number: _______
EXTRA CURRICULAR
Sports, Clubs/Groups & Community Volunteer Service
Ø Using
only the space provided below, please list the activities you
participated in during high school, in the order of importance to
you.
Ø DO NOT
ATTACH A TYPED LIST AND PLEASE PRINT
LEGIBLY.
Ø Indicate
which school year(s) you participated in each activity.
Ø Only include
hours performed outside of the
school day & in Ohio County for Community Service.
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SPORTS (In or outside of school) |
9 |
10 |
11 |
12 |
Leadership Positions, Awards, Recognition, Etc. |
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School Clubs Community Groups (Include Church, 4-H, etc.) |
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Leadership Positions, Awards, Recognition, Etc. |
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Total Hours |
List Activity Performed Below |
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Page 4 Last 4 Digits of Social Security Number: _______
Application Number: _______
EMPLOYMENT
In the space provided
below, please list paid work experience (including self-employment) during high
school.
Ø If you are listing a parent and/or other family
member/relative under “Employer”, please list only the title of the family
member (I.E. Mother, Father, Aunt, Grandparent, etc.) to maintain student
anonymity and scoring objectivity.
SUMMER EMPLOYMENT (Only Hours worked during
summer)
|
EMPLOYER & ADDRESS |
NATURE OF
WORK (INCLUDE SUPERVISORY POSITIONS) |
DATES OF
EMPLOYMENT |
# OF HOURS
PER WEEK |
# OF WEEKS
PER YEAR |
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ACADEMIC YEAR EMPLOYMENT (Only Hours worked
when school is in session)
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EMPLOYER
& ADDRESS |
NATURE OF
WORK (INCLUDE SUPERVISORY POSITIONS) |
DATES OF
EMPLOYMENT |
# OF HOURS
PER WEEK |
# OF WEEKS
PER YEAR |
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Page 5 Last 4 Digits of Social Security Number: _______
Application Number: _______
TEACHER EVALUATION FORM
Brinson Williamson Memorial Scholarship
Steven W. McHenry Scholarship
PLEASE
REVIEW EACH SCHOLARSHIP CRITERIA PRIOR TO APPLYING TO ANY SCHOLARSHIP
STUDENTS: THIS
TEACHER EVALUATION FORM MUST BE
COMPLETED BY ONLY ONE OF
YOUR CURRENT OR PAST MUSIC TEACHERS. ATTACH
THE FORM TO YOUR COMPLETED APPLICATION IF APPLYING FOR THE: (BRINSON
WILLIAMSON MEMORIAL SCHOLARSHIP AND THE STEVEN W. McHENRY SCHOLARSHIP). If
you are applying for both the Brinson Williamson Memorial Scholarship and the
Steven W. McHenry Scholarship, you may
submit one form for both scholarships.
TEACHER: EACH STUDENT IS ASSIGNED AN
APPLICATION NUMBER. PLEASE REFRAIN FROM USING THE STUDENT’S NAME IN YOUR
EVALUATION.
1. Music class student has taken under
your instruction: ________ Band _______
Chorus _______ Piano
Other:
_________________________________________________________________________________
2. Number of year’s student has been
under your instruction: _________________
3. Please list any honors/achievements
this student has received under your instruction:
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4. If applicable, has this student
served in any leadership capacity under your instruction?
a. _____ Yes _____ No
b. If yes, please list:
__________________________________________________________________
____________________________________________________________________________________
5. Please rate this student from 0-5
(with 0 being the lowest score) in the following areas:
_____ Interest in Music _____ Interest in Learning _____ Self-Motivation
_____ Responsibility _____ Preparedness for Class _____ Team Work ______ Total
Teacher Comments: (Please do not use student’s name, ex: This student has)
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________
_____________________________________________________________________
____________________________
TEACHER’S
SIGNATURE DATE
Page 6 Last 4 Digits of Social Security Number: _______
Application Number: _______
REQUIRED ESSAY
Dana Ballard Scholarship
PLEASE
REVIEW EACH SCHOLARSHIP CRITERIA PRIOR TO APPLYING TO ANY SCHOLARSHIP
BELOW IS THE
ESSAY QUESTION FOR THE: (DANA BALLARD
SCHOLARSHIP)
Please title your essay with name of the scholarship and the essay Question. PLEASE DO NOT USE STAPLES – Please use the essay question below.
In 500 words or less, attach an essay addressing the following:
“What are your plans for the future based on the degree you plan to
pursue?”
The essay must be typed, double-spaced with one-inch margins and the last 4 digits of your social security number typed in the lower right hand corner of the page. DO NOT USE YOUR NAME, YOUR PARENTS’ NAMES AND/OR YOUR RELATIVES’ NAMES ANYWHERE IN YOUR ESSAY. You will be evaluated on spelling and grammar.
REQUIRED ESSAY
Brinson Williamson Memorial Scholarship
Steven W. McHenry Scholarship
PLEASE
REVIEW EACH SCHOLARSHIP CRITERIA PRIOR TO APPLYING TO ANY SCHOLARSHIP
BELOW IS THE ESSAY QUESTION FOR THE:
BRINSON WILLIAMSON MEMORIAL SCHOLARSHIP &
STEVEN W. McHENRY SCHOLARSHIP)
If you are applying for both the Brinson Williamson Memorial
Scholarship and the Steven W. McHenry Scholarship, you may submit one essay for these scholarships only using the
question below. Please title your essay with the name(s) of the scholarship
and the essay Question. PLEASE DO NOT
USE STAPLES – Please use the essay question below.
In 500 words or less, attach an essay addressing the following:
“What musical talent(s) do you possess and how do you share your talent(s)
with others?”
The essay must be typed, double-spaced with one-inch margins and the last 4 digits of your social security number typed in the lower right hand corner of the page. DO NOT USE YOUR NAME, YOUR PARENTS’ NAMES AND/OR YOUR RELATIVES’ NAMES ANYWHERE IN YOUR ESSAY. You will be evaluated on spelling and grammar.
DO
NOT RETURN THIS INSTRUCTION PAGE WITH YOUR APPLICATION
Page 7
APPLICATION
CHECKLIST
DO
NOT RETURN THIS INSTRUCTION PAGE WITH YOUR APPLICATION
ü Read the scholarship criteria.
ü Read the scholarship instructions.
ü Read the application.
ü Complete pages 1-5 of the application.
ü Attach your transcript.
ü Read, complete and attach the Teacher Evaluation Form – pg 6. (McHenry & Williamson Scholarships)
ü Read, complete and attach the required Essays – pg 7. (Ballard, McHenry & Williamson Scholarships)
ü Complete and attach the College Costs Estimator Form (online confirmation page or paper form). (Online instruction sheet is enclosed in the Scholarship Packet. Please call the Foundation office for a paper form of the Estimator at 812-438-9401 – Give yourself plenty of time to complete the Estimator).
ü Paper clip (DO NOT STAPLE) the application and required documents in order from page 1-7. DO NOT INCLUDE INSTRUCTION SHEETS.
ü Make a copy of your application and required documents for your records.
ü Submit the application and required documents to the Rising Sun High School Guidance Counselor before 3:00 p.m. on Thursday, December 1, 2010. Late and incomplete applications will not be considered.
All
submitted applications are considered final
Award
Announcements
Scholarship awards will be announced during the
Rising Sun High School Senior Awards Program in May 2012
591 Smart Drive, Po Box 170 Rising Sun, IN 47040
